ABSTRACT
OBJECTIVE: Problems with clinician-patient communication negatively impact newborn screening, genetics, and all of healthcare. Training programs teach communication, but educational methods are not feasible for entire populations of clinicians. To address this healthcare quality gap, we developed a Communication Quality Assurance intervention. METHODS: Child health providers volunteered for a randomized controlled trial of assessment and a report card. Participants provided telephone counseling to a standardized parent regarding a newborn screening result showing heterozygous status for cystic fibrosis or sickle cell disease. Our rapid-throughput timeline allows individualized feedback within a week. Two encounters were recorded (baseline and after a random sample received the report card) and abstracted for four groups of communication quality indicators. RESULTS: 92 participants finished both counseling encounters within our rapid-throughput time limits. Participants randomized to receive the report card improved communication behaviors more than controls, including request for teach-back (p<0.01), opening behaviors (p=0.01), anticipate/validate emotion (p<0.001) and the ratio of explained to unexplained jargon words (p<0.03). CONCLUSION: The rapid-throughput report card is effective at improving specific communication behaviors. PRACTICE IMPLICATIONS: Communication can be taught, but this project shows how healthcare organizations can assure communication quality everywhere. Further implementation could improve newborn screening, genetics, and healthcare in general.
Subject(s)
Anemia, Sickle Cell/diagnosis , Communication , Counseling , Cystic Fibrosis/diagnosis , Neonatal Screening/methods , Professional-Family Relations , Quality Improvement , Adult , Anemia, Sickle Cell/genetics , Child , Cystic Fibrosis/genetics , Female , Genetic Testing , Humans , Infant, Newborn , Male , Middle Aged , Parents/psychology , Quality Indicators, Health Care , Time FactorsABSTRACT
OBJECTIVE: The objectives were to examine emotion-related language in mothers' narratives about newborn screening, and test the correlations between language and self-reported emotion and behavior. METHODS: Transcripts of interviews with mothers of infant sickle cell carriers were analyzed with word count software for the prevalence of emotion-related words in narratives about newborn screening. Word counts were compared to population norms for spoken language using one-sample t-tests. Anxiety-related words were correlated with self-reported anxiety and avoidance of genetic testing. RESULTS: 187 transcripts were analyzed, in which there was a higher percentage of anxiety words (m=.38%) than population norms (m=.18%), t(186)=10.59, p<.001, CI=.16-.23. Anxiety-related word use was positively correlated with self-reported previous anxiety, rs(185)=.24, p=.001. Self-reported previous anxiety, but not word use, was correlated with mothers' avoidance of undergoing genetic testing themselves rs(152)=.25, p=.002. CONCLUSION: Mothers of sickle cell carrier infants reported anxiety upon learning their child's condition. Anxiety-related words in maternal narratives were correlated with their reports of past, but not present, emotions. PRACTICE IMPLICATIONS: Researchers and clinicians should use caution in assuming that word choices reflect state emotions. Self-report methods may be preferable for predicting behavioral outcomes.
Subject(s)
Anemia, Sickle Cell/diagnosis , Emotions , Linguistics , Mothers/psychology , Neonatal Screening/psychology , Anemia, Sickle Cell/genetics , Female , Genetic Testing , Humans , Infant , Infant, Newborn , Interviews as Topic , Male , Surveys and QuestionnairesABSTRACT
Well-organized conversation can improve people's ability to comprehend and retain information. As part of a long-term effort to adapt Quality Improvement techniques for communication, we developed an explicit-criteria method to assess usage of three organizing behaviors (OBs): 'opening behaviors' to establish goals; 'structuring behaviors' to guide patients through conversation; and 'emphasizing behaviors' that signal a need for attention. Pairs of abstractors independently reviewed transcripts in a demonstration sample of conversations between physicians and standardized parents after newborn screening identifies carrier status for sickle cell disease. Criteria for at least one OB were identified in 50/84 transcripts (60%), including 27 with at least one opening behavior (32%), 5 with at least one structuring behavior (6%), and 38 with at least one emphasizing behavior (45%). The limited number of OBs raises concern about communication after newborn screening. Assessment and improvement of OB usage may improve understanding and allow parents to more actively participate in health care.
